“If my side is unable to agree on an adequate replacement, then some kind of action with regard to private health insurance markets must occur,” he said at a Rotary Club meeting in Kentucky.

The gloomy outlook highlights why McConnell had sought to finish work on the repeal-and-replace legislation before the July 4 recess.

McConnell didn’t want his members to face additional pressure over the break, and he also wasn’t keen on spending more time on healthcare. His conference now faces a marathon three-week session to take action on the issue.

The caucus remains deeply divided with rank-and-file members signaling they don’t believe they are close to a deal that could capture 50 votes.

“We're still several weeks away from a vote, I think,” Sen. Pat Toomey (R-Pa.) said a televised Q & A event, while dozens of protesters urged him to oppose the Senate bill.

Moran added that there wasn’t “significant consensus” on how to fix healthcare.

“[It’s] almost impossible to try to solve when you're trying to do it with 51 votes in the United States Senate, in which there is not significant consensus on what the end result ought to be,” he said.

Leadership held a flurry of closed-door negotiations before the recess as they tried to reach deals that would win over undecided lawmakers, including adding more money for opioid treatment.

With a slim 52-seat majority, McConnell can only afford to lose two GOP senators and still let Vice President Pence break a tie. With Hoeven’s defection there are roughly 10 GOP senators publicly opposed to the bill.

“Compared to how optimistic I was the week before now ... I’m very pessimistic,” Grassley told constituents in Mount Pleasant, Iowa, before adding that he thinks Congress will get something done even if repeal now and replace later.

Republicans have campaigned for years on repealing and replacing ObamaCare, arguing the Affordable Care Act is “failing” and in a “death spiral,” and insisting that the law is not fixable.

McConnell’s staff were quick to note that the GOP leader’s comments are similar to remarks he made after a closed-door meeting with Senate Republicans and Trump at the White House. But the pivot comes as McConnell is trying to wrangle his caucus behind his legislation even as conservatives appear to be digging in for a fight.

If the warning was meant to be a signal to unruly Republicans that it was either the Senate bill or working with Democrats, there was no sign they had an immediate impact.

“No, none. We’ve reached out to Senate Republican leadership,” Paul told reporters. “We’ve described some of the things with the association plans...and we have not gotten any feedback. Now I talked to the president about it, and he was very receptive.”

But the demand has riled GOP aides and other members of the caucus, who are accusing Cruz of making unrealistic demands that can’t get 50 votes. GOP leadership has sent two versions of their bill to the CBO, one that would include Cruz’s proposal and one without.

Just hours after McConnell’s comments, Cruz became the latest GOP senator to call for simply repealing ObamaCare without a replacement plan as a plan B.

“We have had – for seven years – we have promised to do that,” Cruz said. “Repealing Obamacare was the single biggest factor producing a Republican House, a Republican Senate and, I think, ultimately a Republican president.”

The move would either require Republicans to get 60 votes for a replacement plan or use the fiscal year 2018 budget as a vehicle, scrapping their plans for tax reform.

Senate GOP leadership has signaled the idea is a non-starter even after it got the backing of Trump and a growing number of senators.

Sen. Ben Sasse (R-Neb.) told local reporters that he was willing to see if McConnell could “get the ball across the finish line” by the time lawmakers return to Washington, but if not he supported separating repeal and replace.

“If we can't get this done instead of walking away from either repeal or replace ... I don't want that to happen,” he said. “So I think it would be a more prudent legislative step to unbundle repeal and replace.”